Ontogeny of hepatic methionine catabolic enzyme activities (Transmethylation and Transsulphuration) and associated physiological amino acids in E10-21 chick embryos and D1-49 broilers.

Developmental changes in hepatic methionine adenosyltransferase, cystathionine ß-synthase, cystathionase, and glycine N-methyltransferase were determined in broiler chick embryos and hatched chicks by using radiometric and spectrometric methods. Hepatic free methionine, S-adenosylmethionine, S-adenosylhomocysteine, homocysteine, cystathionine, and cysteine levels were also investigated. Results showed an increase in hepatic MAT activity from E10 to E21 during embryogenesis, suggesting greater transmethylation rates throughout the rapid embryonic growth and development period. A strong positive correlation between embryo BW and MAT activity also supports this idea. The MAT specific activity continued to increase after hatching, but there was a negative correlation between chick BW and MAT activities from D1 to D49. This may indicate different MAT isozymes exist for chick embryo hepatic tissue compared to hepatic tissue of hatched chick and growing broilers. The developmental pattern of MAT isozymes could be critical for methionine metabolism to cope with the demand imposed on the embryo, chicks, and growing broilers. Additionally, the specific activity of hepatic CBS in chick embryos was determined to be lower compared to that observed in older broilers (35 and 49 days). Since liver CBS specific activity is at the lowest point from D1-7 in young chicks, the ability to convert adequate homocysteine to cysteine through transsulphuration may be limiting for cysteine synthesis at this time. Steady-state hepatic homocysteine levels in chick embryos and chicks may be a function of the rates of homocysteine formation, remethylation, and catabolism via the transsulphuration pathway. The present study indicates young chicks from D1 to D7 may have a limited ability for adequate transsulphuration; therefore, dietary cystine may be needed for optimum performance.

Effects of dietary energy levels on Pectoralis major mixed muscle protein turnover and body composition in two broiler lines housed in different grow-out environments.

This study determined the Pectoralis (P) major mixed muscle protein turnover (PT) in two meat broiler lines, Line A and Line B, during the finishing grow-out feeding period (21-42 days) as affected by the dietary metabolizable energy (ME) levels and ambient temperatures. Experimental finishing diets consisted of 80, 90, 100, 110 and 120% ME of recommended nutrient guidelines for energy level. Fractional synthesis rates (FSR) or fractional degradation rates (FDR) were measured in P. major at day 36 and 42. Protein and fat mass gain were measured, and respective energy retention efficiencies as protein and fat (EREp and EREf) were determined. Metabolic heat production (HP) was also reported. Experimental feeding studies were conducted in cool season (24 hr mean: 69.91˚F and 63.98% RH) and in hot season (24 hr mean: 77.55˚F and 86.04% RH). Results showed that FSR or FDR values were not affected by dietary ME levels at day 36, whereas reduced FSR (p < .05) were observed at day 42 fed diets with reduced ME levels (≤100% ME) which could have resulted from greater maintenance energy requirement of maturing broilers at that age. Broilers fed reduced ME diets (≤100% ME) maintained protein mass (equivalent to broilers fed ≥100%-120% ME) by reduced FDR and increased feed intake. Grow-out ambient temperature did not affect FSR or FDR values across ME levels. Line B retained higher protein mass, lower fat mass and greater HP compared to Line A. This was followed by higher feed intake in Line B. Further, Line B exhibited higher EREp and lower EREf across dietary ME levels. In summary, PT homeostasis and body composition changes in broiler lines studied seemed to be regulated by the birds' intent to normalize energy intake as per physiological need by controlling feed intake.

Developmental changes in physiological amino acids and hepatic methionine remethylation enzyme activities in E10-21 chick embryos and D1-49 broilers.

The remethylation of homocysteine to methionine is important for chick embryos to sustain the S-adenosylmethionine transmethylation reactions, which are essential for the rapid proliferation of cells. Developmental changes in hepatic 5-methyltetrahydrofolate-homocysteine methyltransferase (MFMT), betaine-homocysteine methyltransferase (BHMT) and hepatic serine hydroxymethyltransferase (SHMT) were determined in E10-21 Cobb 500 broiler chick embryos and hatched chicks from D1-49. Hepatic levels of free serine, glycine, putrescine, spermidine and spermine levels were also determined. Analyses showed hepatic MFMT-specific activity doubled from E10 to E12, with remaining embryo development experiencing small fluctuations in activity through E21. Hepatic MFMT doubled immediately after hatch, with peak activity occurring at D3. Afterwards, hepatic MFMT-specific activity steadily declined from D7-49. Hepatic BHMT activity was higher from E10 to E16 of embryogenesis, decreased rapidly at E17 and remained lower through E21 (p < .05). Hepatic BHMT-specific activity was also lower in chicks, with the exception of a peak in specific activity on D7. BHMT activity returned to lower levels by D21. Throughout embryogenesis, hepatic SHMT activity in chick embryos remained relatively constant except for a decrease at 13E, followed by an increase at 14E. Maximal activity of SHMT was found the first day post-hatch. Additionally, SHMT activity was significantly lower in growing chicks than that in embryos. Hepatic-free serine and glycine levels were negatively correlated with SHMT in hatched chicks. Hepatic polyamine, putrescine and spermidine shared a similar development pattern: peak level in the middle of incubation, low at late embryogenesis and lowest during the post-hatch period except an increase within one week after hatch. The sharp increase in hepatic concentrations of glycine, serine and putrescine, along with increased specific activities of MHMT, BHMT and SHMT from D1-7, suggests that methionine conservation (remethylation from homocysteine) and glycine/serine is critical for young chicks for organ growth, maturation, and development.

L-Carnitine metabolism, protein turnover and energy expenditure in supplemented and exercised Labrador Retrievers.

L-Carnitine is critical for protection against bioaccumulation, long-chain fatty acid transportation and energy production. Energy production becomes important as the body maintains lean mass, repairs muscles and recovers from oxidative stress. The aim was to investigate the effects of supplemented L-carnitine on protein turnover (PT), energy expenditure (EE) and carnitine metabolism in muscle/serum of Labrador Retrievers. In a series of experiments, all dogs were fed a low-carnitine diet and sorted into one of two groups: L-carnitine (LC) supplemented daily with 125 mg L-carnitine and 3.75 g sucrose or placebo (P) supplemented with 4 g sucrose daily. The experiments consisted of analyses of muscle/serum for L-carnitine content (EXP1), a protein turnover experiment (EXP2) and analysis of substrate utilization via indirect calorimetry (EXP3). EXP1: 20 Labradors (10 M/10 F) performed a 13 week running regimen. L-Carnitine content was analysed in the serum and biceps femoris muscle before/after a 24.1 km run. LC serum had higher total (p < .001; p = .001), free (p < .001; p = .001) and esterified (p = .001; p = .003) L-carnitine pre- and post-run respectively. LC muscle had significantly higher free L-carnitine post-run (p = .034). EXP2: 26 Labs (13 M/13 F) performed a 60-day running regimen. For the final run, half of the Labradors from each treatment rested and half ran 24.1 km. Twenty-four Labradors received isotope infusion, and then, a biopsy of the biceps femoris of all 26 Labradors was taken to determine PT. Resting/exercised LC had a lower fractional breakdown rate (FBR) versus P group (p = .042). LC females had a lower FBR v. P females (p = .046). EXP3: Respiration of 16 Labradors (8 M/8 F) was measured via indirect calorimetry over 15 week. All dogs ran on a treadmill for 30 min at 30% VO2 max (6.5 kph), resulting in higher maximum and mean EE in LC females v. P females (p = .021; p = .035). Implications for theory, practice and future research are discussed.

Effects of dietary amino acid levels and ambient temperature on mixed muscle protein turnover in Pectoralis major during finisher feeding period in two broiler lines.

Two broiler lines A and B were fed experimental diets from 21 to 42 days with an objective to determine Pectoralis major protein turnover (PT) as affected by the dietary amino acid (AA) levels and ambient temperature. Experimental diets (n = 9 replicate pens per diet) were formulated to 3,150 kcal/kg with five levels of digestible lysine (dLys) -80, 90, 100, 110 and 120% of recommended AA level giving g dlys/Mcal values of 2.53, 2.85, 3.17, 3.48 and 3.80 respectively. All other AA was formulated to a fixed ratio to dLys. Fractional synthesis or degradation rates (FSR or FDR) of P. major were measured on day 36 and day 42 for all dietary treatment levels for both broiler lines using stable isotope of AA (15 N-phenylalanine) as metabolic tracer. Experimental feeding studies were conducted once in hot season (24-hr mean ~ 85.3°F; 80.9% RH) and repeated in cool season (24-hr mean ~ 71.6°F; 61.7% RH) of the year. The FSR values increased (p < .05) as digestible AA in diet increased for both broiler lines in hot season until break point FSR occurring at 106.2% AA level. The average FSR values measured were higher for Line B at day 36 (20.98%/D for Line B vs. 20.69%/D for Line A) and at day 42 (16.07%/D for Line B vs. 12.47% D for Line A). FDR values observed at day 36 and day 42 were not different between lines (p > .05). Similar trends but elevated values of FSR and FDR in cool season than in hot season were recorded for both the lines. Line B showed the higher mixed muscle protein accretion (%/D) than Line A by actually increasing the FSR which was correlated by higher lean mass deposition and higher feed intake (p < .05). The overall findings indicated that PT response in P. major due to effects of digestible AA levels and ambient temperature was different and line-specific.

Comparative Effectiveness of Multifaceted Outreach to Initiate Colorectal Cancer Screening in Community Health Centers: A Randomized Controlled Trial.

INTRODUCTION: Colorectal cancer (CRC) screening rates are low among vulnerable populations. Fecal immunochemical tests (FITs) are one screening modality with few barriers. Studies have shown that outreach can improve CRC screening, but little is known about its effectiveness among individuals with no CRC screening history. We sought to determine whether outreach increases FIT uptake among patients with no CRC screening history compared to usual care. METHODS: This study was a patient-level randomized controlled trial, including 420 patients who had never completed CRC screening and were eligible for FIT; 66% were female, 62.1% were Latino, and 70.7% were uninsured. The main outcome measure was FIT completion within 6 months of the randomization date. We assessed FIT completion at different time points corresponding to receipt of outreach components. All analyses were re-run with 12-month data. RESULTS: Patients who received outreach were more likely to complete FIT than those in usual care (36.7% vs. 14.8%; p < 0.001). FIT completion was more common among patients with increased clinic visits. The difference in FIT completion between the outreach and usual care groups decreased over time. DISCUSSION: The intervention improved FIT uptake among patients with no CRC screening history. However, the intervention was less effective than in a previous trial targeting patients due for repeat screening. Additional research is needed to determine the best methods for improving CRC screening among this hard-to-reach group.

Design of a randomized controlled trial to assess the comparative effectiveness of a multifaceted intervention to improve adherence to colorectal cancer screening among patients cared for in a community health center.

BACKGROUND: Colorectal cancer (CRC) is common and leads to significant morbidity and mortality. Although screening with fecal occult blood testing (FOBT) or endoscopy has been shown to decrease CRC mortality, screening rates remain suboptimal. Screening rates are particularly low for people with low incomes and members of underrepresented minority groups. FOBT should be done annually to detect CRC early and to reduce CRC mortality, but this often does not occur. This paper describes the design of a multifaceted intervention to increase long-term adherence to FOBT among poor, predominantly Latino patients, and the design of a randomized controlled trial (RCT) to test the efficacy of this intervention compared to usual care. METHODS: In this RCT, patients who are due for repeat FOBT are identified in the electronic health record (EHR) and randomized to receive either usual care or a multifaceted intervention. The usual care group includes multiple point-of-care interventions (e.g., standing orders, EHR reminders), performance measurement, and financial incentives to improve CRC screening rates. The intervention augments usual care through mailed CRC screening test kits, low literacy patient education materials, automated phone and text message reminders, in-person follow up calls from a CRC Screening Coordinator, and communication of results to patients along with a reminder card highlighting when the patient is next due for screening. The primary outcome is completion of FOBT within 6 months of becoming due. DISCUSSION: The main goal of the study is to determine the comparative effectiveness of the intervention compared to usual care. Additionally, we want to assess whether or not it is possible to achieve high rates of adherence to CRC screening with annual FOBT, which is necessary for reducing CRC mortality. The intervention relies on technology that is increasingly widespread and declining in cost, including EHR systems, automated phone and text messaging, and FOBTs for CRC screening. We took this approach to ensure generalizability and allow us to rapidly disseminate the intervention through networks of community health centers (CHCs) if the RCT shows the intervention to be superior to usual care. TRIAL REGISTRATION: ClinicalTrials.gov NCT01453894.

The Relationship between Performance, Body Composition, and Processing Yield in Broilers: A Systematic Review and Meta-Regression.

This study aims to model the relationship among performance, whole body composition, and processing yield through meta-regression. Scientific papers found in Scopus and Google Scholar were included if they reported results and variability values of an actual experiment in the three mentioned groups of variables using a single broiler genetic line. Weighted mean effect sizes were determined with a random model, the risk of bias was determined, and heterogeneity was considered an indicator of usefulness. Meta-regressions considered the effect sizes of the response variable and the percent change in one or more variables as predictors. A 78-row database was built from 14 papers, including nine factors tested on 22,256 broilers. No influencing bias was found, and the data was determined useful. Meta-regressions showed that the changes in body weight gain (BWG) are inversely related to the effects in feed conversion ratio (FCR) (p < 0.001) and that the changes in FCR and effects in protein-to-fat gain (PFG) are directly related (p < 0.001). The changes in PFG and the effects on carcass conformation or the market value of birds are directly related (p < 0.001). In conclusion, body composition predicts carcass conformation and its market value, supporting its use to predict the economic value of broilers.

Woody breast myopathy broiler show age-dependent adaptive differential gene expression in Pectoralis major and altered in-vivo triglyceride kinetics in adipogenic tissues.

A study was conducted to understand the differentially expressed genes in Pectoralis (P) major under woody breast (WB) myopathy condition in a high yielding broiler strain using RNA-sequencing at the growing (d 21) and finishing (d 42 and d 56) grow-out ages. Follow-up study was conducted to understand the in vivo triglyceride (TG) synthesis (d 49) occurring in adipogenic tissues using deuterium oxide (2H2O) as a metabolic tracer. Results indicated the top physiological systems affected in myopathy broiler were related to the musculo-skeletal system (d 21, 42, and 56) and cardiovascular system (d 42 and 56). Ubiquitin-specific proteases are expressed higher in myopathy broiler at d 21 (OTUD1) and d 42 (SACS) that potentially indicated higher degradation of muscle protein occurring at those ages. While genes related to transcription factors and muscle cell differentiation (ZNF234, BTG2) and muscle growth (IGF1) were upregulated with myopathy broiler suggesting concurrent muscle fiber regeneration. The downregulation of PYGB and MGAM genes related to carbohydrate transport and metabolism at d 42 potentially indicated nutrient-deficient state of myopathy affected fibers; whereas the nutrient-deficient physiological state of cells seemed to be counteracted by up-regulation of genes related to carbohydrate (ALDOB, GPD1L2) at d 56. There was a reduced (P < 0.05) in vivo TG synthesis in liver of the myopathy broiler (0.123 %/hr) compared to non-myopathy broiler (0.197 %/hr). The majority of TG synthesized in liver with myopathy broiler could conceivably be delivered to P. major (rather than to abdominal fat pad storage) to fulfil the increased energy need of muscle cells (via TG lipolysis and fatty acid [FA] oxidation). The increased utilization of FAs in the WB affected muscle could result in reduced secretion of FAs into blood circulation leading to sub-optimal availability of FAs for re-esterification for TG synthesis in liver. Results indicated that myopathy broiler at later age (d 56) of grow-out period were synchronously going through adaptive physiological processes of feedback responses to adverse cellular states.

Effects of dietary energy levels on performance and carcass yield of 2 meat-type broiler lines housed in hot and cool ambient temperatures.

Two meat-type broiler lines, line A and line B were fed experimental diets from 22-42 d with objectives to determine the effects of dietary metabolizable energy (ME) levels on feed intake (FI), performance, body composition, and processing yield as affected by environmental grow-out temperatures. Two thousand fifty male chicks from line A and 2,050 male chicks from line B were reared in 90-floor pens, 45 chicks per pen utilizing primary breeder nutrition and husbandry guidelines for starter (1-10 d) and grower (11-21 d) phases. Experimental finisher diets consisted of 5 increasing levels of apparent nitrogen corrected ME (2,800, 2,925, 3,050, 3,175, and 3,300 kcal/kg set at 19.5% crude protein and 1.0% dLys at each level) to represent 80, 90, 100, 110, and 120% ME of Evonik AminoChick energy level giving 2 × 5 factorial design and were fed from 22-42 d. All other amino acid levels in diets were formulated to a fixed ratio of dLys level. There were nine replicate pens for each diet and each line. The experiment was conducted twice-once in hot season (barn averages: 77.55 ˚F and 86.04% RH) and another in cool season (barn averages: 69.91 ˚F and 63.98% RH) of the year. Results showed that FI and feed conversion ratios (FCR) decreased (P < 0.05) linearly (R2 = 0.9) by 61.25 g and 0.073 units for every 10% increase in dietary ME for combined analysis of lines and seasons. The % fat mass of total body mass increased by 0.57%, whereas % protein mass decreased by 0.21% across ME levels (R2 > 0.9). However, there was no difference (P > 0.05) in % weights (of live weight) for wings, breast filet, tenders, or leg quarters across ME levels for both lines except % fat pad that increased (P < 0.05) by 0.20% for each 10% increment in dietary ME level. Line B had higher cumulative FI, BW gain, % lean, and protein mass of body mass than line A in hot season (P < 0.05). Feed intake was not different between lines in cool season (P > 0.05), whereas higher BW and improved FCR were observed for line A. Line A had higher % fat mass in both seasons. In summary, performance and yield results as affected by dietary ME levels were line specific and were affected by grow-out seasons. The optimal dietary ME level for the ME range studied (2,800-3,000 kcal/kg) at a constant recommended amino acid level lies in determining the best performance and profitability indices by taking into account the grow-out production inputs and processing yield outputs.

In vivo collagen and mixed muscle protein turnover in 2 meat-type broiler strains in relation to woody breast myopathy.

Two meat-type broiler strains, strain A and strain B, were reared in floor pens (25 birds/pen; 45 pens/strain) for pectoralis (P) major collagen and mixed muscle protein turnover (PT) study from 0-56 D using primary breeder nutrition and husbandry guidelines. Forty broilers (n = 10/strain for collagen PT; n = 10/strain for mixed muscle PT) were selected at each sampling age at day 21, 28, 35, 42, and 56 and infused with 1-13C proline (Pro) and 15N-phenylalanine (Phe) which are used as amino acid tracers for collagen and mixed muscle PT measurements, respectively. Muscle and plasma samples were collected, and enrichments of 1-13C Pro and 15N-Phe were determined using mass spectrometry. Fractional synthesis rate (FSR) and fractional degradation rate (FDR) were measured for collagen and mixed muscle using precursor-product principle. At day 42, after separating the sampled broilers as myopathy (woody breast [WB] score > 1) and nonmyopathy (WB = 0), plasma metabolites were screened for differential 3-methyhistidine (3-MH) expression for both strains. Data were analyzed using one-way ANOVA using t test. Results showed that collagen and mixed muscle FSR and FDR in pectoralis major decreased (P < 0.05) for both strains as the broilers aged. FSR for collagen and FDR for mixed muscle were higher for strain B than those for strain A (P < 0.05). Total collagen was higher (P < 0.05) for strain B. Differentially expressed 3-MH in plasma was higher (P < 0.05) for myopathy-affected broilers indicating greater muscle degradation occurring in myopathy-affected broiler types for both strains. 3-MH Expression in plasma was higher for strain B than for strain A. The research findings showing an increased collagen content per unit muscle weight in pectoralis major in strain B (than in strain A) could be due to higher mixed muscle FDR and increased collagen FSR occurring during the grow-out period. The increased degradation of muscle fibers and probable replacement of muscle-specific protein with connective tissue, mainly collagen, was an evident pathophysiological phenomenon occurring in myopathy-affected broilers.

Effect of digestible amino acids to energy ratios on performance and yield of two broiler lines housed in different grow-out environmental temperatures.

Two broiler lines, Line A and Line B, were fed experimental diets from 22 to 42 d with objectives to determine effects of digestible amino acids (AA) to metabolizable energy ratios on feed intake (FI), performance, and processing yield. Experimental diets were formulated to 3,150 kcal/kg with 5 levels of digestible lysine (dLys)-80, 90, 100, 110, and 120% of recommended AA level giving g dLys/Mcal values of 2.53, 2.85, 3.17, 3.48, and 3.80, respectively. All other AA were formulated to a fixed ratio to dLys. A total of 4,050 chicks were utilized in each trial (9 replicate pens for each AA level and each line; 45 chicks/pen) conducted twice: one in hot environmental temperature (HT) (24 h mean ∼85.3 °F; 80.9% RH) and another in cool environmental temperature (CT) (24 h mean ∼71.6 °F; 61.7% RH). Results showed that FI was not impacted by dietary AA levels in HT for both lines. Higher FI (P < 0.05) was observed in CT for lower dietary AA levels (<100% AA level) for both lines, with overall higher FI occurring in Line B. Higher FI for Line B was also accompanied by higher body weight in HT and CT. Treatment diets had quadratic effects on average daily gain (ADG), feed conversion ratio (FCR), and processing yields (breasts and tenders) in both HT and CT, with broilers in CT performing better (P < 0.05). The optimal response values for ADG in HT and CT were 89.72 g and 113.44 g occurring at 120 and 109.5% AA level, respectively. The optimal response values for FCR in HT and CT were 1.79 and 1.58 occurring at 120 and 117.5% AA level, respectively. The optimal response values for breast meat yield in HT and CT were 575.9 g and 776.5 g occurring at 112.6 and 114.5% AA level, respectively. The optimal response values for tender meat yield in HT and CT were 119.8 g and 154.9 g occurring at 120 and 115% AA level, respectively. Line A had a higher breast and tender yield % (of live weight) for both environmental temperatures which correlated to body composition data with higher % protein mass and % digestible AA retention. In this study, findings indicated that effects of increased digestible AA density on FI, performance, and processing yield are specific to strain and grow-out temperature, but the optimum response was attained for both lines with diets containing 110 to 120% AA levels (3.48-3.80 g dLys/Mcal) during the 22 to 42 d finisher period.

Characterizing Woody Breast Myopathy in a Meat Broiler Line by Heat Production, Microbiota, and Plasma Metabolites.

Selection for quantitative traits in meat broilers such as breast yield and growth rate exert physiological pressure leading to ante mortem histological and biochemical alterations in muscle tissues. The poultry industry has recently witnessed a myopathy condition affecting Pectoralis major (breast muscle) of broilers, called woody breast (WB), an etiology still unclear to scientific community. A study was conducted to characterize the WB myopathy in a meat broiler line at its finishing phase (d 41) in terms of heat production (HP), microbiota and plasma metabolites. Two treatment groups were studied-WB affected (myopathy) and normal (non-myopathy) broiler; n = 20 in each group. Indirect calorimetry was utilized for HP measurement. Furthermore, body composition (BC) analysis was also performed using dual-energy x-ray absorptiometry (DEXA). Microbiota in ileal digesta was studied with PCR amplified 16s rRNA gene. LC-MS targeted metabolomics was performed to understand differential expression of plasma metabolites. Results showed that there was difference in fasting HP (P < 0.05) between these two treatment groups, with non-myopathy broiler producing more heat which was indicative of higher body protein content validated by higher protein: fat ratio by BC results. Less protein content in myopathy bird could be due to probable higher mixed muscle degradation occurring in lean tissue as marked by elevated 3-methylhistidine expression in plasma. Microbiota results showed unclassified Lactobacillus as predominant genus with higher abundance occurring in myopathy group; whereas at species level, L. acidipiscis was predominant bacteria for non-myopathy broiler. Differentially significant metabolites (P < 0.05) identified from plasma metabolome between these two treatment groups were homocysteine, cyclic GMP, trimethylamine N-oxide (TMAO), tyramine, carnitine, and acetylcarnitine, which were all associated to cardiovascular system. The findings suggest that more research in meat broilers could be opted toward delivering reduced vascularity issues to alleviate this myopathy condition.

Comparative effectiveness of a multifaceted intervention to improve adherence to annual colorectal cancer screening in community health centers: a randomized clinical trial.

IMPORTANCE: Colorectal cancer (CRC) screening rates are lower among Latinos and people living in poverty. Fecal occult blood testing (FOBT) is one recommended screening modality that may overcome cost and access barriers. However, the ability of FOBT to reduce CRC mortality depends on high rates of adherence to annual screening. OBJECTIVE: To determine whether a multifaceted intervention increases adherence to annual FOBT compared with usual care. DESIGN, SETTING, AND PARTICIPANTS: Patient-level randomized controlled trial conducted in a network of community health centers. Included were 450 patients who had previously completed a home FOBT from March 2011 through February 2012 and had a negative test result: 72% of participants were women; 87% were Latino; 83% stated that Spanish was their preferred language; and 77% were uninsured. INTERVENTIONS: Usual care at participating health centers included computerized reminders, standing orders for medical assistants to give patients home fecal immunochemical tests (FIT), and clinician feedback on CRC screening rates. The intervention group also received (1) a mailed reminder letter, a free FIT with low-literacy instructions, and a postage-paid return envelope; (2) an automated telephone and text message reminding them that they were due for screening and that a FIT was being mailed to them; (3) an automated telephone and text reminder 2 weeks later for those who did not return the FIT; and (4) personal telephone outreach by a CRC screening navigator after 3 months. MAIN OUTCOMES AND MEASURES: Completion of FOBT within 6 months of the date the patient was due for annual screening. RESULTS: Intervention patients were much more likely than those in usual care to complete FOBT (82.2% vs 37.3%; P < .001). Of the 185 intervention patients completing screening, 10.2% completed prior to their due date (intervention was not given), 39.6% within 2 weeks (after initial intervention), 24.0% within 2 to 13 weeks (after automated call/text reminder), and 8.4% between 13 and 26 weeks (after personal call). CONCLUSIONS AND RELEVANCE: This intervention greatly increased adherence to annual CRC screening; most screenings were achieved without personal calls. It is possible to improve annual CRC screening for vulnerable populations with relatively low-cost strategies that are facilitated by health information technologies. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01453894.